Sciatica: What is the Source?

One of the most common things that I see in my office is Sciatica. In fact, many patients come to their first visit and tell me straight away that they have sciatica. Self diagnosis is common today as you can find anything you want on the internet. However, what most people don’t understand is that sciatic symptoms can have multiple different causes. This means that sciatica treatment can vary depending on the primary cause. The real trick is to uncover the true source. Is is stemming from poor soft tissue health in the low back? Scar tissue build-up in the hips and glutes? Poor pelvis function? Poor lumbar spine function? A herniated disc in the lower back? Poor postural position of the low back and pelvis? Or more commonly, is it a combination of many of these? Many times therapists take a cookie-cutter approach to sciatica. Adjusting the lumbar spine and pelvis, stretches for the piriformis, and maybe some electrical stimulation to the area. This can sometimes help overcome the pain and symptoms, but most of the times function is never addressed. This is the real source of the problem. Some dysfunction in postural positions or movement has taken place that led to the problem. Unless this is addressed the problem is likely to return.

The other issue I see is that people many times have an MRI that is done because of nerve symptoms that are present. While this is not a bad idea you always have to remember that the pain is not always caused by what is found in the MRI. For example, if you take an MRI of someone’s low back, many times you are likely to find that is does not look perfect. You may find some mild narrowing of spaces or even some mild disc bulging. This does not mean that you can automatically assign these findings to the source of all the patient’s pain. This is why many times surgery to the lumbar spine fails to resolve the patients complaints. The surgeon did a great job at making the MRI look ‘normal’, but it may not have been the actual thing that was causing the symptoms in the first place. In fact, in the vast majority of cases conservative care will be enough to take care of the symptoms and restore function without pain. However, there needs to be a comprehensive approach to this care. You must address the soft tissue health, the proper joint function, the nerve health, postural positions, strength capacity, AND movement patterns. You cannot just pick one and roll the dice. If you fail to correct postural and movement patterns then treatment will likely fail or the problem will shortly reoccur. We see this many times in our office as patients come to us after numerous other practitioners have failed to resolve the problem. This is not because they are bad at the services they provide, it is simply because they did not address all of the problems at the same time.

Understand the basic premise behind sciatica treatment is taking pressure off of the sciatic nerve, wherever the compression may be happening. Whether this is caused by scar tissue, poor joint movement, or poor functional patterns, it doesn’t really matter. All we have to do is uncover all the dysfunctions, restore normal function, and then let the body heal on its own. If you are suffering from sciatica, just make sure that your sciatica treatment program is comprehensive and addressing all these areas to ensure you the best chance for success.